Current Concepts of Cerebrovascular Disease Alcohol and Stroke

Cardiovascular Effects Alcohol has various cardiovascular effects. Acute ingestion may be associated with increased cardiac rate and output, depression of left ventricular contractile function, increased systolic blood pressure and pulse pressures, diminished preload and systemic vascular resistance, cutaneous vasodilation at the expense of splanchnic constriction, and increased coronary blood flow in response to an alcohol-induced increase in myocardial oxygen consumption." When used in moderation, alcohol may reduce the incidence of death caused by coronary heart disease. Heavy alcohol ingestion, however, is associated with several cardiovascular complications that place the patient at risk for ischemic brain infarction. One such complication is the "holiday heart" syndrome. Ettinger and colleagues described cardiac rhythm disturbances, including 12 examples of atrial fibrillation, among 24 patients aged 25-62 years with recent heavy alcohol ingestion and known past prolonged excessive ethanol use. Episodes usually followed heavy weekend or holiday drinking sprees. After resolution of the arrhythmias, most patients were asymptomatic. At cardiac catheterization none had evidence of important heart disease. Except for transient hypokalemia in 4 patients, elevated blood alcohol levels in 6 of 8 patients (range 50-430 mg %), and persistent liver dysfunction in 1, blood chemistries were normal. Delirium tremens was diagnosed in 2 patients; stroke was not reported. Cardiac arrhythmias occurring during weekend or holiday drinking sprees might also be a symptom of cardiomyopathy. Early states of alcoholic cardiomyopathy may be reversible, but with continued alcohol consumption, congestive heart failure and cardiac arrhythmias develop. At necropsy cardiomegaly, ventricular dilatation and hypertrophy, and mural